Introduction

The word “Alopecia” means hair loss, which comes from the Greek word Alopekia meaning baldness. Alopecia can occur on any part of the body where hair grows, which can be mild hair thinning or complete baldness over the affected area.¹ There are various types of alopecia based on the cause behind it.

What is Traction Alopecia?

Traction Alopecia is a type of alopecia in which hair loss is caused by tension created on the hair follicles due to hair pulling.² Hair pulling is generally caused by tight hairstyles, hair extensions-wigs etc. Let us understand the causes behind Traction Alopecia in detail.

What are the causes of Traction Alopecia?

Tight Hairstyles

Hairstyles like braids, ponytails, and buns involve tightly pulled hair, if such hairstyles are carried for extended periods, the prolonged tension damages the hair follicles.³

Hair extensions and wigs

The excess weight of hair extensions and wigs puts stress on the hair follicles leading to damage and hair loss.

Use of tight headgear

The use of helmets, tight headgear, scarves, and hats can also pull the hair causing stress and damage to hair follicles leading to hair loss.

Use of excess heat on hair 

 Excess use of hair styling tools like hair dryers, hair straighteners, and curling irons set at higher temperatures damages hair shafts and hair follicles which indirectly contributes to traction alopecia.

Chemical treatments  

Various hair chemical treatments also contribute to traction alopecia by damaging hair follicles.

What are the signs and symptoms of Traction Alopecia?

Thinning of hair

The first obvious sign which is noticed is the thinning of hair. This is more prominent in the areas where hair is pulled tightly.⁴

Scalp irritation and redness

The area where hair is pulled tightly becomes red, inflamed and irritated because of the tension on the hair follicles and surrounding skin.

Pain 

Pain, and tingling can also be present when the hairstyle is too tight, or hair extensions are too heavy.

Scalp infections

 Sometimes it can also lead to infection of hair follicles called folliculitis.

Scarring 

if scalp infections are left untreated they can cause permanent scarring of hair follicles making hair regrowth extremely difficult

Bald patches 

Over time the constant pulling damages the hair follicles leading to significant hair loss causing bald patches

If you notice any of these symptoms consult your healthcare provider and after initial assessment, you can be referred to a dermatologist or trichologist for further analysis and treatment options.

Diagnosis of Traction Alopecia

Medical History

• You will be asked about the kind of hairstyles you normally do and for how long, any hair extensions, headgear, or hair adornments that you use which might be creating tension on the hair in the affected area
• The frequency of use of hair styling tools like hair dryers, straighteners, and curlers as the heat from these tools worsens the traction alopecia
• Amount, duration and type of chemical treatments on your hair that you are undergoing as it adds to more stress and further weakening of the hair follicles
• Other medical history to rule out other types of alopecia

Physical examination 

It involves assessment of the affected area of the scalp for signs of redness, itching, inflammation, swelling and patches of baldness. The density of hair on the affected area where tension is applied is also compared with the density of hair on other areas of the scalp to get an idea about the severity of the condition.

Microscopic examination

Here a dermatoscope is used to study the scalp skin and hair follicles to understand the extent of damage.

Hair pull test  

in this test, your hair strand is gently pulled to see if the hair comes out to understand the extent of damage and weakness of the hair follicles.

Biopsy

In very rare cases biopsy where a sample of your scalp skin is taken and sent for analysis. This is done to rule out any other causes of alopecia

Complications of Traction Alopecia

Inflammation 

Constant pulling and tension can lead to irritation, redness, and itching of the scalp skin and hair follicles.

Infection 

Chronically inflamed skin is more prone to infections further damaging the hair follicles and leading to increased hair loss.

Scar

If the skin inflammation and associated infections are still not treated in time it can lead to scarring of the scalp skin causing permanent damage to the hair follicles and therefore permanent hair loss.

Permanant hair loss 

Continuous strain on hair follicles damages the hair follicles and weakens the hair shaft over time. Once the hair follicles are damaged beyond repair it leads to permanent hair loss.

Psychological distress 

 if the hair loss is extensive and visible it leads to emotional stress as it starts affecting appearance. This can give rise to issues like low self-esteem, social isolation and in some cases anxiety and  depression

Treatment for traction alopecia

Hair Care Measures

In the early stages, preventive measures can be enough to address Traction Alopecia like

• Avoid tight hairstyles or reduce the duration for which such hairstyles are carried. Adopt loose hairstyles which will not add excess strain on hair follicles and hair shafts
• Avoid or reduce the use of heat-producing equipment for hairstyles
• Do not expose the hair to any chemical treatment and reduce the use of chemical products used for hairstyling to reduce the damage to the hair scalp and hair follicles
• Do not put excess pressure when combing hair, especially wet hair. Use a wide teeth comb to comb your hair
• If these measures are applied early on before any significant damage to the hair follicles Traction Alopecia can be reversed and hair can regrow in the affected area⁵

Medicines

If the affected area is showing signs of inflammation, then Topical (local) applications over the affected area need to be prescribed

• Corticosteroids: corticosteroid cream is prescribed if the affected area is inflamed. This controls the inflammation and allows the hair follicles to recover
• Minoxidil: Topical Minoxidil cream is recommended to be applied to the affected area to promote regrowth of hair in the affected area

Laser treatment

 Low-level laser therapy improves blood circulation in the affected area which can improve hair growth in the affected area.

Plasma therapy 

Here the patient’s plasma Is injected in the scalp to promote growth of new hair in the affected area.

Hair transplant

In extreme cases where the follicles are permanently damaged hair transplant is recommended to address the issue.

Summary

The word “Alopecia” means Hair loss, which comes from the Greek word Alopekia meaning baldness. Alopecia can occur on any part of the body where hair grows, which can be mild thinning of hair or complete baldness over the affected area. In Traction Alopecia, hair loss is caused by the weakening of hair follicles due to the tension created by hair pulling. The use of hair styling equipment, and chemical treatments further contribute to the worsening of traction alopecia. The affected area can get inflamed and prone to infections and scarring leading to permanent damage to the hair follicles. Damaged hair follicles are unable to support the hair shaft leading to easy breakage and increased hair fall.  If left untreated this can cause patches of baldness over time. Traction alopecia is reversible if addressed in time by avoiding tight-fitting hairstyles, hair extensions wigs, and heavy headgear. To control the inflammation topical steroids can be used and for hair growth topical ointments like minoxidil can be used under professional advice. Laser therapy and hair transplant are some of the treatment options for advanced cases of Traction Alopecia.